I have been diagnosed with bipolar II, mostly having episodes of depression
and a secondary hypomanic state one time brought on by a TCA. I recently
was put on Prempro for menopause and became severely depressed. Do you
know of any HRT that would be the least likely to cause depression? thank
you. Susan

Hello Susan --
Read the Q/A here about hysterectomy for
another example of someone seeing mood effects from something related to
hormone control. Unfortunately, although evidence is rapidly accumulating
to show that hormones (like hormone replacement therapy - HRT) can dramatically
affect mood in some people, we still don't know how to adjust our mood
treatment efforts accordingly.

I hear about mood-hormone relationships a great deal from my bipolar
patients. In any given person, it seems that estrogen can have: a)
no effect at all; b) a mood improving effect -- that's quite common; or
c) the effect you've experienced, becoming depressed. Perhaps this
shouldn't be such a surprise: when people are given steroids like "Prednisone"
for immune system problems, they can have manic episodes -- but they can
also have depressive experiences. And as you know, estrogen is a
steroid hormone.

As you may also know, there is still a fair bit of controversy about
HRT approaches even for women who don't have known mood problems: how much,
and what progesterone form if any, are two major issues. Which form
and approach to use in your case depends of course, and first of all, on
why you're taking HRT in the first place. But, unfortunately, how
to vary that approach given your mood history, and now your mood symptoms
on estrogen -- is not known. So regardless of why you're taking it,
we have to approach your problem from the symptoms, not from the cause.
OK, if you have to take HRT (an open question?), then take it and we treat
the depression -- tricky, in your case, given that history of hypomania.
I'd think strongly of lithium for it's antidepressant effect, and lamotrigine
for the same reasons. Beyond those options, it gets really tricky.

See if you can find a mood specialist in your state who works
from a women's clinic. Call one of the bigger hospitals in your area
and see if you can find someone who knows of one. Or try the "find
a therapist tools" and then select only those who have experience with
"hormones and mood": you could ask for a "one-time consultation"
if they say they're not taking new patients (that may or may not work!).